Competencies of MO-PHI

# Competency Description/ activities pertaining to the said competency Competency Assessment methods  
  1 Diagnose TB Correctly and completely based on NTEP guidelines/Standards of TB Care in India - Identify individuals vulnerable to develop TB disease and TB Infection. 
- Screen for TB using 4 symptom complex and Chest X ray and identify presumptive TB 
- Prescribe appropriate diagnostic test to diagnose TB/ EP-TB, DR-TB, paediatric TB and TB Infection to the eligible based on NTEP guidelines/ Standards of TB Care in India 
- Enroll a person in Ni-kshay and request for Test through Ni-kshay based on NTEP Diagnostic algorithms and requirements for UDST 
- Enter the diagnosis details of clinically diagnosed TB in Ni-kshay
- Implement Intensified Case Finding in the Facility 		 1. Verification of case records in Ni-kshay to check whether correct tests are prescribed and the diagnosis is complete including testing for drug resistance 2. Interview with Medical Officer to understand his/her practice in relation to diagnosis of TB and adherence to diagnostic algorithm and request appropriate tests.
3. Assess OPD referral rates of presumptive TB Cases and random prescription audits for referral for TB Testing of presumptive TB Cases
4. Interviews with people affected with TB under care of the MO to check whether cases are diagnosed completely based on referral for testing and test results.
5. Review of Test Request (Referral for testing) Registers to check for appropriate referral of patients or their samples for higher diagnostic tests which are not available in the current health facility.		  
2 Prescribe and initiate TB treatment to a person diagnosed as TB/ TBI - Check reports of various laboratory and radiological investigations and interpret the results to make a diagnosis of TB or TB Infection and decision to treat based on microbiological or radiological evidences or on clinical judgement
-Classify the TB disease based on site of disease, DST results and history of anti-TB treatment.
- Prescribe appropriate regimen to treat people affected with DS-TB, H Mono/Poly TB, TB Infection based on NTEP guidelines/ Standards of TB Care in India according to weight bands for adult and paediatricsx
-Identify an appropriate treatment supporter in consultation with the person affected with TB
- Evaluate & advise for indoor admissions based on differrentiated TB care model
- Modify regime (based on laboratory results and clinical examination, special conditions such as TB in pregnancy, renal impairment, adverse events following anti-TB treatment, liver functions impairment etc.) based on program guidelines 
-Document the treatment initiation and details of prescription in Ni-kshay		 1. Verification of case records and treatment card in Ni-kshay to check whether correct regimens are prescribed 
2. Interview with Medical Officer to understand current prescription practices 
3. Interview with patients under care of MO and assess whether right regimen are prescribed
4. Review of Ni-kshay module for differentiated TB care which is updated for all the patients for the TB unit		    
3 Perform pre-during-and post-treatment evaluation of people affected with TB/DR-TB/TB Infection, as per programme guidelines/ STCI - Cousel for Perform or coordinate for pre-treatment evaluation of people affected with DS-TB/ DR-TB/ TB Infection 
- Conduct periodic clinical follow up and prescribe appropriate laboratory follow-up for people on treatment for DS-TB/DR-TB/TB Infection
- Prescribe and arrange for post treatment follow-up investigations as per programme guidelines 
- Document all evaluation details in Ni-kshay  		 1. Verification of case records in Ni-kshay/ Treatment cards or prescriptions to check whether all evaluations are done correctly 
2. Interview with Medical Officer to understand current practice of pre-during-post evaluations 3. Interview with patient/beneficiaries under the MO's care to check whether all evaluations are done correctly
4. Review Status of post Treatment followup in cases notified in Nikshay for the past year		    
4 Identify and manage Adverse Drug Reactions due to anti-TB drugs   - Screen for adverse drug reactions to anti-TB drugs among people on treatment 
-Detect and grade ADRs due to anti-TB treatment 
-Evaluate adverse reactions of anti-TB medicines and manage them appropriatly based on NTEP guidelines 
-Counsel people affected with TB/TBI about nature, consequences of ADRs and changes in treatment rehimen to address the ADRs
- Document the ADRs on Ni-kshay  		 1. Verification of case records in Ni-kshay and treatment records to see ADR's were identified and managed 
2. Interview with Medical Officer to understand the practices related to ADR identification and management including referral to higher centres
3. Interview with patient/beneficiaries under MO's care to understand whether ADRs are identified and managed properly		    
5 Transfer persons affected with TB/DR-TB, to higher center/ nearest health facility for appropriate management, correctly and timely - Identify the need for referral of people affected with TB for availaing various services 
-Refer the beneficiary following standard operations including documentation in Ni-kshay 
- Coordinate with respective program staff for continuation of care post referral 		 1. Verification of case records in Ni-kshay and treatment records to check whether referral is correct and timely
2. Interview with MO to understand the current prictise related to referral 
3. Interview patients/beneficiaries under MO's care to check whether referral is prompt 		    
6 Evaluate and mange person affected with TB for medical co-morbidities and conditions  - Screen people diagnosed with TB for co-morbidities like Diabetes, HIV, Malnutrition, COVID-19 and sustance abuse like Tobacco Use, Alcohol use
-Mange the co-morbidity and link them to appropriate services whereever required
- Document the co-morbidity status in Ni-kshay		 1. Verification of case records in Ni-kshay to check whether screening and management of co-morbidity are done as per guidelines
2. Interview MO to understand current practices regarding co-morbidity management
3. Interview beneficiaries/ patients under MO's care to check whether co-morbidities are screened and managed properly		    
7 Counsel the people with presumptive TB or people affecetd with DS-TB/DR-TB/ TBI and their family  - Counsel the people with persumptive TB/ people affected with TB/TBI on: Early and complete Diagnosis of TB, correct and complete Treatment of TB, Treatement Adherence, Air borne Infection Control, Contact Investigation, TB Preventive Therapy, Co-morbidty management, Adverse Drug Reactions and Social welfare measures 1. Interview with Medical Officer to understand current practises regarding counselling
2. Interview with patients/ beneficiaries to understand the quality of counselling received from MO		    
8 Ascertain treatment outcomes as per NTEP guidelines - Ascertain appropriate outcome of the prescribed treatment as per NTEP guidelines.
- Document treatment outcomes in Ni-kshay		 1. Verification of records in Ni-kshay to check whether outcome assigned are correct
2. Interview with people who had their outcome assigned to check whether the outcome assigned were correct		    
9 Monitor NTEP and perform supportive supervision in the health facility and in the population served by the health facility -Monitor the NTEP program at facility level and at the level of population served by the facilty, 
-Use Ni-kshay reports and other program reccords/registers, and supervise all services/ processes reach their logical conclusion. Incase of any difficulty inform higher program management (MOTU/ DTO) for further action. 
-Monitor the input and process indicators related to the output/outcome indicator and suggest corrective actions 
- Conduct supportive supervision and help in building capacity of nursing, paramedical and field staff with an intention to improve quality of services. 
- Provide timely and actionable feedback to health sub-centers and reporting field staff (ANM, ASHA, TB-HV, STS, STLS, MPW, CHO, etc.)
- Ensure the staff are supported in taking the actions leading to an improvement in quality of services		 1. Verification of review meeting minutes, documentation of feedbacks provided and supervisory registers to check qulaity of monitoring, review and supervision activities
2. Interview with MO to understand the current practises regard to Monitoring, Review and Supportive supervision
3. Interview with staff (ANM, ASHA, TB HV, STS, MPHW, CHO, Nurse, Pharamacist etc.) supervisied by MO to get an understanding about the quality of supportive supervision and review 		    
10 Advocacte with Local Government, Private providers and community for engaging them for TB Elimination activities in the field area of health facility  - Advocate with Local Government (Panchayat/ Municipality) to commit for Ending TB 
-Technically assist Local Government in planning and implimenting TB Elimination activities including fostering community ownership, decentralised surveillance, organising treatment support to needy, air borne infection control at household, community, hospitals and workplaces, intersectoral coordination with other line departments. -Advocate with and successfully engage private health delivery service providers to ensure citizens reaching them are receiving care as per the STCI -Conduct meetings like "patient provider meetings, TBHV-ASHA-ANM/MPHW-Treatment Supporter meetings, various committee meetings (Rogi Kalayan Samiti/ RKS, Jan Arogya Samiti/ JAS, Village Health Sanitation, and Nutrition Committee/ VHSNC, Mahila Arogya Samiti/ MAS, DRTB Center committee, Medical College Core-committee, District TB Forum, etc.), discuss the desired changes with related to TB Program and achieve the same.		 1. Check for any results of advocacy in terms of commitment from Local Government, engagement of private providers, engagement of community
2. Interview with private practitioners and Local Government leaders to get an understanding about the MO's competency